维持性血液透析患者高同型半胱氨酸血症和心脏结构的相关性分析

Associations between hyperhomocysteinemia and cardiac structure in maintenance hemodialysis patients

目的探究维持性血液透析(maintenance hemodialysis,MHD)患者高同型半胱氨酸血症与心脏结构的相关性。方法回顾性分析2014年1月~2021年12月首都医科大学附属北京朝阳医院MHD患者的一般资料和临床资料,血浆同型半胱氨酸(homocysteine,Hcy)≤30μmol/L为正常-轻度组,Hcy>30μmol/L为中-重度组。比较左心室超声指标,分析Hcy与其是否相关,探究Hcy与心血管疾病其他危险因素对左心室结构功能的交互作用。结果共纳入176例患者,正常-轻度组74例,中-重度组102例。2组患者左心室舒张末期内径(left ventricular end diastolic dimension,LVDd)(Z=-2.569,P=0.01)、左心室收缩末期内径(left ventricular end systolic dimension,LVDs)(Z=-2.813,P=0.005)、室间隔厚度(interventricular septal thickness,IVST)(Z=-3.389,P=0.001)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)(Z=-2.463,P=0.014)及左心室舒张早期二尖瓣血流速度峰值(E)/二尖瓣心房收缩期血流速度峰值(A)比值(Z=-3.483,P<0.001)差异有统计学意义。Hcy与LVDd(r=-0.206,P=0.006)、LVDs(r=-0.190,P=0.011)、E/A(r=-0.234,P=0.002)呈负相关,与IVST(r=0.356,P<0.001)、LVPWT(r=0.243,P=0.001)呈正相关。多元回归分析显示Hcy与LVDd(β=-0.263,P<0.001)、LVDs(β=-0.223,P=0.004)、IVST(β=0.294,P<0.001)、LVPWT(β=0.244,P=0.002)独立相关。Hcy与体质量指数(β=0.405,P<0.001)对IVST存在交互作用;Hcy与性别(β=-0.164,P=0.038)、体质量指数(β=0.386,P<0.001)、透析前收缩压(β=0.225,P=0.004)对LVPWT存在交互作用。结论MHD患者高同型半胱氨酸血症是心脏结构改变的独立危险因素,血Hcy水平与性别、体质量指数、透析前收缩压对心脏结构改变存在交互作用。

Objective To investigate the associations between hyperhomocysteinemia and cardiac structure in maintenance hemodialysis patients(MHD).Methods 176 MHD patients in Beijing Chao-Yang Hospital Affiliated to Capital Medical University from January 2014 to December 2021 were analyzed retrospectively.Patients whose plasma homocysteine(Hcy)≤30μmol/L were divided into the normal-mild group,and whose plasma Hcy>30μmol/L were divided into moderate-severe groups.The indexes of left ventricular by cardiac ultrasound were compared between the 2 groups,and the correlation between plasma Hcy and left ventricular indexes was analyzed.We also explored whether there was an interaction between plasma Hcy and other risk factors of cardiovascular disease on left ventricular structural and functional.Results 74 patients were enrolled in the normal-mild group,and 102 patients were enrolled in the moderate-severe group.There were significant differences in left ventricular end-diastolic dimension(LVDd)(Z=-2.569,P=0.010),left ventricular end-systolic dimension(LVDs)(Z=-2.813,P=0.005),ventricular septal thickness(IVST)(Z=-3.389,P=0.001),left ventricular posterior wall thickness(LVPWT)(Z=-2.463,P=0.014)and the peak of early diastolic flow velocity E/the peak of atrial flow velocity A(Z=-3.483,P<0.001)between normal mild-group and moderate-severe group.Plasma Hcy level was negatively correlated with LVDd(r=-0.206,P=0.006),LVDs(r=-0.190,P=0.011)and E/A(r=-0.234,P=0.002),positively correlated with IVST(r=0.356,P<0.001)and LVPWT(r=0.243,P=0.001).Multiple regression analysis showed that plasma Hcy level was correlated with LVDd(β=-0.263,P<0.001),LVDs(β=-0.223,P=0.004),IVST(β=0.294,P<0.001),LVPWT(β=0.244,P=0.002)independently.Plasma Hcy level interacted with body mass index(BMI)(β=0.405,P<0.001)on IVST;Plasma Hcy level interacted with gender(β=-0.164,P=0.038),BMI(β=0.386,P<0.001)and systolic blood pressure(SBP)(β=0.225,P=0.004)on LVPWT.Conclusion Hyperhomocysteinemia was an independent risk factor for cardiac structure changes in MHD patients,and there was an interaction between blood Hcy level and gender,BMI,and SBP before dialysis on cardiac structure changes.